The impact of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE-eligible (aged 19-25 years, n = 1,924) and DCE-ineligible (aged 27-34 years, n = 8,313) colorectal cancer patients from the National Cancer Database during 2007-2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early stage diagnosis among DCE-eligible (15 percentage points increase, p<.001), but not DCE-ineligible (p = .09) patients. DCE-eligible patients resected for IIB-IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (HR = 1.34, CI = 1.05, 1.71; 7.0 days decrease in restricted mean time from surgery to chemotherapy, p=.01), with no differences in DCE-ineligible patients (HR = 1.10, CI = 0.98, 1.24; 2.1 days decrease, p=.41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially life-saving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy.

中文翻译：

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根据负担得起的医疗法案扩大相关覆盖范围后的年轻成年患者的大肠直肠癌治疗。

根据《可负担医疗法案》（ACA）进行的家属覆盖范围扩大（DCE）对接受大肠癌治疗的影响尚未确定。我们从2007-2013年的美国国家癌症数据库中确定了新诊断为DCE的大肠癌患者（19-25岁，n = 1,924）和DCE不合格的（27-34岁，n = 8,313岁）大肠癌患者。所有统计检验都是两面的。ACA后，符合DCE资格的患者在早期诊断上有统计学上的显着增加（增加15个百分点，p <.001），但不符合DCE的患者（p = .09）。符合DCE资格的IIB-IIIC大肠癌切除患者更有可能及时接受辅助化疗（HR = 1.34，CI = 1.05，1.71；从手术到化疗的限制性平均时间减少7.0天，p = .01），ACA后没有DCE资格的患者没有差异（HR = 1.10，CI = 0.98，1.24；减少2.1天，p = .41）。我们的研究结果突出了ACA在改善潜在的挽救生命的癌症护理服务中的作用，包括转向早期诊断和更及时地接受辅助化疗。